Impact of Federal Hospital Policies Sharp Rise In Urban Hospitals With Rural Status In Medicare (Health Affairs) Yang Wang, Jared Perkins, Christopher Whaley, Ge Bai This article aims to quantify the impacts of Geisinger Community Medical Center v. Secretary, United States Department of Health and Human Services, and Lawrence Memorial Hospital v. Burwell, which began allowing hospitals [...] The post The Source Roundup: September 2025 Edition appeared first on The Source on HealthCare Price...| The Source on HealthCare Price and Competition
In 2022, the California legislature passed Assembly Concurrent Resolution No. 95, mandating the California Law Revision Commission (CLRC) study specific topics relating to antitrust law and its enforcement. The bill made legislative findings that included “[t]he idea that America has a monopoly problem is now beyond dispute”, “California should be uniquely sensitive to the threat of market concentration”, and “[n]o California statute deals expressly with monopolization or attempte...| The Source on HealthCare Price and Competition
Steering methods, where health plans are able to incentivize patients to choose high-value, cost-effective care can be critical to the financial health of these plans. New York–Presbyterian Hospital is facing mounting legal and regulatory challenges over allegations that it sought to limit competition and prevent insurers from steering patients to lower-cost options. On July 25, [...] The post Recent Anti-steering Suit Against New York Presbyterian Hospital Mirrors Concerns in DOJ Inves...| The Source on HealthCare Price and Competition
On June 12th, 2025, Vermont Governor Phil Scott signed S0126 into law, in which the state aims to improve quality of care and healthcare access by stabilizing healthcare costs through Medicare-based price regulation, creating global hospital budgets, and establishing a more stable and high-quality state healthcare network. The new law intends to do so through controlling costs for commercial insurance, managing hospital costs by using price caps, and overseeing and assessing administrative ...| The Source on HealthCare Price and Competition
On May 10, California Governor Gavin Newsom released the “May Revise” to his initial January proposal for California’s 2024-2025 budget. The revised budgetary proposal lays out $288 billion in total spending [1], a reduction of $3.5 billion from his initial January proposal [2]. The decreased budget proposal reflects the increase in the state deficit, originally projected to be $38 billion, now forecasted to exceed $45 billion, [1]. This is a $17.6 billion difference from the Governor...| The Source on HealthCare Price and Competition
Healthcare Consolidation Defining Health Care “Corporatization” (The New England Journal of Medicine) Erin C. Fuse Brown In this brief article, Fuse Brown draws on the prescient work of Paul Starr who, in his 1982 book the Social Transformation of American Medicine, foretold the coming of large healthcare conglomerates. Through consolidation, concentration, and increased focus on profits [...] The post The Source Roundup: August 2025 Edition appeared first on The Source on HealthCare Pri...| The Source on HealthCare Price and Competition
In April 2025, Arkansas passed legislation prohibiting pharmacy benefit managers (PBMs) from acquiring or holding a direct or indirect interest in pharmacies. This law makes Arkansas the first state to enact a structural approach to address concerns about PBM business practices. To date, three separate lawsuits have been filed challenging the law. This article looks at how PBMs work, previous attempts to regulate them, and the current lawsuits opposing the Arkansas law. While the laws...| The Source on HealthCare Price and Competition
In January, Governor Newsom released his proposed budget for the 2025-2026 fiscal year with hopes of a strong fiscal position and a surplus for California that has not been seen in recent years. However, in the face of multiple federal and state spending decisions, the final budget bill signed on June 27, 2025, although balanced, [...] The post California’s Final 2025-2026 Budget Requires Significant Compromises appeared first on The Source on HealthCare Price and Competition.| The Source on HealthCare Price and Competition
On July 3, 2025, a three-judge panel of the 9th U.S. Circuit Court of Appeals upheld an Oregon state law that allows the state to review, approve or deny proposed health care mergers, affirming a lower court ruling from May of last year. History of the Case The Oregon Association of Hospitals and Health Systems [...] The post Oregon’s Powerful Healthcare Merger Review Law Survives Legal Challenge appeared first on The Source on HealthCare Price and Competition.| The Source on HealthCare Price and Competition
Healthcare Cost Control State Health Care Cost Commissions: Their Priorities and How States’ Political Leanings, Commercial Hospital Prices, and Medicaid Spending Predict Their Establishment (The Milbank Quarterly) Brent D. Fulton, Daniel R. Arnold, Jordan M. Wolf, Richard M. Scheffler As healthcare costs continue to rise, states play an increasingly important role in addressing affordability and cost containment. In this Milbank Quarterly article, researchers examine the political and econ...| The Source on HealthCare Price and Competition
On May 21, 2025, a three-judge panel of the Sixth Circuit Court of Appeals in Ohio reversed a lower court’s decision to dismiss a case filed by Tiara Yachts against Blue Cross Blue Shield of Michigan (BCBSM). The rulings hinged on whether BCBSM acted as an Employee Retirement Income Security Act (ERISA) fiduciary when administering Tiara Yachts’ self-funded insurance plan. The lower Court had ruled that BCBSM’s actions did not qualify as fiduciary conduct under ERISA, claiming that ...| The Source on HealthCare Price and Competition
On May 14, Governor Newsom released the May revision to the initial 2025-2026 California budget proposal that was released in January. The May Revise proposes a total expenditure of $321.9 billion, representing a $300 million decrease from the January estimate. Despite a projected surplus in the January budget, changing national economic conditions and increased expenditure growth (especially in Medi-Cal) have resulted in a $12 billion deficit in the updated budget. In 2024, the budget’...| The Source on HealthCare Price and Competition
Rural Healthcare Access Rural Hospital Closures Led to Increased Prices at Nearby ‘Surviving’ Hospitals, 2012-22 (Health Affairs) Caitlin Carrol, Jessica Chang Research on how consolidation affects healthcare pricing largely centers on mergers rather than closures. Hospital closures, especially those in rural areas, reallocate patient populations to nearby ‘surviving’ hospitals posing distinct effects on the remaining healthcare market. In theory, reallocation of a patient population ...| The Source on HealthCare Price and Competition
Market Consolidation and Merger Review The Forgotten Anti-Monopoly Law: The Second Half of Clayton Act Section 7 (Texas Law Review) Robert H Lande, John M Newman, Rebecca Kelly Slaughter The authors of this article analyze the second prong of Section 7 of the Clayton Act, which prohibits mergers that “tend to create a monopoly.” In comparison to the well-known first prong that seeks to “substantially lessen competition,” the second prong is posited to wield more statutory power as it ...| The Source on HealthCare Price and Competition
The California State Legislature kicked off the first year of its 2025-2026 biennial Legislative Session on December 2, 2024. This year, the legislature got off to a sprinting start as it raced to meet the February 21, 2025 deadline to introduce new bills. Compared to last year, this year’s legislature proposed a wider swath of bills aimed at healthcare-related concerns, including enhanced merger review, the use of artificial intelligence (AI) in healthcare, and expanding access to both pro...| The Source on HealthCare Price and Competition
Department of Justice Looking Into United Health On February 21, 2025, the Wall Street Journal reported that the Department of Justice (DOJ) has launched a civil fraud investigation against UnitedHealth. The investigation is centered on Medicare billing practices, with sources saying that UnitedHealth-employed physicians were trained to document higher revenue-generating diagnoses, even if that was not what patients were being treated for. Additionally, the investigation is apparently loo...| The Source on HealthCare Price and Competition
On December 23, 2024, Aetna (part of CVS Health) filed a lawsuit against Radiology Partners and its private equity backers in the U.S. District Court for the Middle District of Florida – Jacksonville Division. The suit claims Radiology Partners, one of the nation’s largest imaging groups, manipulated the No Surprises Act (NSA) and its dispute resolution process to boost payments improperly. Aetna’s filing called this a “multiphase healthcare fraud scheme” that defrauded Aetna of...| The Source on HealthCare Price and Competition
On January 10, 2025, Governor Newsom released his proposed California state budget for the 2025-26 term. Following last year’s $46 billion budget shortfall, the Governor’s new budget looked quite different this year. Specifically, the budget had no deficits, reporting a projected surplus of $363 million due to the state’s prediction that it will collect almost $17 billion more in revenue than was originally planned. In fact, this year is slated to go down as California’s second-larges...| The Source on HealthCare Price and Competition
Healthcare Pricing Can Public Option Plans Improve Affordability? Insights From Colorado (Health Affairs Forefront) Roslyn Murray, Christopher M. Whaley In the face of individuals and families unable to afford increasing insurance premiums due to lack of healthcare insurance competition, a variety of states are considering offering public option plans, commonly for ACA Exchange plans. These plans seek to provide coverage with low premiums by means of capped prices for those who do not meet Me...| The Source on HealthCare Price and Competition
In November of 2024, three lawsuits were filed by pharmaceutical manufacturers against the Department of Health and Human Services (HHS) and the Health Resources and Services Administration (HRSA), challenging how HRSA oversees the Federal 340B Drug Pricing Program. (HRSA is the sub-agency within HHS that administers the 340B Program). The potential impact of the lawsuits on the 340B Program is significant in its own right, but the outcome of the lawsuits could also have an indirect effect ...| The Source on HealthCare Price and Competition
The California legislation concluded the 2024 legislative session when it adjourned on August 21, 2024. Overall, the legislature introduced a variety of health care bills spanning a list of hot-topic issues from Medi-Cal eligibility to health care worker minimum wage increases. Below we recap noteworthy bills from the 2024 legislative session impacting California’s health care market that were not enacted (to learn what bills were enacted please see Recapping the 2024 California Legislative...| The Source on HealthCare Price and Competition
Price Transparency Hospital Payment Caps Could Save State Employee Health Plans Millions While Keeping Hospital Operating Margins Healthy (Health Affairs) Roslyn C. Murray, Christopher M. Whaley, Erin C. Fuse Brown, Andrew M. Ryan As health insurance premiums continue to rise, state employee health plans are occupying an increasing portion of state budgets. State employers are often the largest purchaser or commercial health insurance in each state, given the volume of employees that they emp...| The Source on HealthCare Price and Competition
Healthcare market oversight at the federal level is primarily done through litigation brought by the Federal Trade Commission (FTC) or the Department of Justice (DOJ). Any change in administration in Washington will change the focus and priority of these agencies. Nonetheless, the second Trump administration has indicated that it will make wholesale changes to federal agencies, including the FTC and DOJ, that exceed those that are typical during a change in administration. These indicat...| The Source on HealthCare Price and Competition
Healthcare Competition and Consolidation Chang(ing) Health Care: Bigger May Not Be Better, Just Necessary (Health Affairs Forefront) Atul Grover, Jonathan B. Jaffery As the health care market increasingly trends towards consolidation, many have been left wondering whether the trend towards amalgamated efficiency truly is better. The authors of a new Health Affairs article are arguing that the answer is no. Specifically, they state that the trend towards larger, more consolidated entities is r...| The Source on HealthCare Price and Competition
Healthcare Competition and Consolidation The Rise of Health Care Consolidation and What to Do About It (Health Affairs Forefront) Erin C. Fuse Brown, Yashawini Singh, Christopher M. Whaley, Jared Perkins As hospital consolidation continues to meteorically rise, an increasing number of government institutions including the Federal Trade Commission, the Department of Justice, and Congress, have diverted move resources towards understanding and responding to the negative impacts of these trends....| The Source on HealthCare Price and Competition
On Saturday, Sept 18, 2024, Governor Gavin Newsom vetoed California AB 3129, legislation that would have created a requirement for the Attorney General to review and give approval before private equity groups could buy into certain health care facilities and providers (previously reported on by The Source). In his veto message, the Governor stated that the Office of Health Care Affordability (OHCA), established in 2022, “was created as the responsible state entity to review proposed heal...| The Source on HealthCare Price and Competition
New laws and rules requiring greater transparency into the behaviors and reimbursements of insurers have given employees and employers a clearer picture of where their healthcare dollars are going. For example, the “Transparency in Coverage” rule, implemented in October 2020, required health plans and insurers to post rates they negotiate with providers and develop price transparency tools related to cost-sharing. The “Consolidated Appropriations Act”, passed in 2021, requires Thi...| The Source on HealthCare Price and Competition
Assembly Bill 2200, better known as the Guaranteed Health Care for All Act, which seeks to establish a universal single-payer healthcare system called CalCare has once again failed. Assemblymember Ash Kalra’s newest attempt at a single-payer bill is the most current in a long line of attempts to secure universal healthcare for Californians. In 2022, we wrote about Assembly Bill 1400, a single-payer universal healthcare bill that would see coverage expand to every resident within the state o...| The Source on HealthCare Price and Competition
Healthcare Competition and Consolidation Vertical Integration and Market Consolidation in Healthcare: Policy Drivers and Impact on Physicians and Patient Care (Seminars in Colon and Rectal Surgery) Rachel Ekaireb, Anna Yap, and Robert Kucejko Over the past several decades, the healthcare market has become increasingly consolidated. For instance, in the last twelve years alone, the percentage of physicians employed by hospitals or healthcare systems has more than doubled from 26% to 55%. While...| The Source on HealthCare Price and Competition
No Decision in AAEM-PG v. Envision Case: A Potential Precedent-Setting Corporate Practice of Medicine and Private Equity Case is Avoided A decision in the long-anticipated case, the American Academy of Emergency Medicine Physician Group (AAEM-PG) v. Envision Healthcare, will not come to pass, as Envision, a private equity-backed emergency physician staffing company, choose to exit the California market. In a press release, AAEM-PG stated a concern about whether a California court could re...| The Source on HealthCare Price and Competition
Healthcare Competition and Consolidation Medicare Advantage and Consolidation’s New Frontier — The Danger of UnitedHealthcare for All (New England Journal of Medicine) Hayden Rooke-Ley, Soleil Shah, and Erin C. Fuse Brown This article describes the recent ransomware attack on Change Healthcare and the ownership structure of UnitedHealth Group, including how much market power it has with medical claims, data analytics, insurance, physicians, PBMs, pharmacies and a bank. The authors note ...| The Source on HealthCare Price and Competition
In late June Novant announced it would abandon attempts to buy two Community Health Systems (CHS) hospitals in North Carolina. This announcement followed a preliminary ruling in Federal District Court for Novant and a subsequent appellate court ruling for the Federal Trade Commission (FTC). Regardless of the final outcome of the merger, the preliminary Novant win is significant because it represents a successful use of the often cited, rarely successful, “failing firm” defense – which...| The Source on HealthCare Price and Competition
Mergers, Acquisitions and Healthcare Competition Is There Too Little Antitrust Enforcement in the U.S. Hospital Sector? (American Economic Association) Zarek Brot-Goldberg, Zack Cooper, Stuart Craig, Lev Klarnet From 2002 to 2020, there were more than 1,100 hospital mergers with a 1% enforcement rate by the FTC resulting in only 13 blocked transactions. The authors of this study speculate low rates of enforcement could be due to factors including budgetary issues and jurisprudence that favors...| The Source on HealthCare Price and Competition
On May 16, 2024, a Federal District Court Judge dismissed a case filed in 2022 by the Oregon Association of Hospitals and Health Systems (OAHHS, the trade group representing hospitals in Oregon) against the State of Oregon and the Oregon Health Authority (OHA). The suit challenged the law created by Oregon HB 2362, 2021 legislation that required health care entities that meet minimum thresholds to obtain state approval before any mergers or acquisitions. The new law created the Health Car...| The Source on HealthCare Price and Competition
Effects of Market Consolidation Cost, Quality, and Utilization After Hospital-Physician and Hospital-Post Acute Care Vertical Integration: A Systematic Review (Medical Care Research and Review) Alexandra Harris, Sarah Philbin, Brady Post, Neil Jordan, Molly Beestrum, Richard Epstein, Megan McHugh To determine the impact of vertical integration, the authors examine the associations between two types of integration, hospital-physician and hospital-Post Acute Care (PAC), and their effect on cost...| The Source on HealthCare Price and Competition
Healthcare Cost and Spending Promoting Value-Based Healthcare Decisions: A Case Study of Shared Savings Programs in New Hampshire and Maine (Pepperdine Policy Review) Christopher LaCreta and Lawson Mansell Shared savings programs (SSPs) are an emerging policy solution to combatting the rise of healthcare costs. SSPs enable patients to compare prices and receive incentives for saving money on some elective services. Researchers from Pepperdine University’s School of Public Policy recently pu...| The Source on HealthCare Price and Competition
